With just over a week into his second term, President Donald Trump faces a major policy challenge: tackling Big Pharma and lowering prescription drug prices. A recent Gallup poll shows that while only 34 percent of Americans trust both him and Congress to get the job done, Trump alone performs better: 43 percent believe he will prioritize reducing prescription costs.
That’s a crucial distinction. While Republicans rallied behind him in 2024, and key swing states secured his victory, public confidence in Congress remains abysmally low at just 17 percent. This means that if Trump wants to make an impact on drug pricing, he will have to pressure both Republicans and Democrats in Congress to fall in line.
The Problem: Pharma’s Influence in Washington
Most Americans don’t follow the intricacies of health care policy, but they do recognize when corporate interests and political deal-making undermine progress.
Case in point: the recent spending showdown in Congress. Rep. Chip Roy publicly called out an attempt to slip in a pro-Big Pharma provision that would have weakened insurers’ ability to negotiate lower drug prices. This effort, rumored to be spearheaded by Sen. Bill Cassidy, ultimately failed due to public scrutiny, but there’s concern that similar provisions could reappear in future negotiations.
Cassidy has also been a major player in Congress pushing to dismantle the 340B drug discount program, which requires pharmaceutical companies to provide lower-cost drugs to hospitals serving low-income and rural communities. This program directly benefits working-class Americans (many of whom vote Republican). Louisiana, which has twice sent Cassidy to Congress, has a lot of rural, working-class voters.
Big Pharma has been aggressively fighting back against state-level protections for 340B. They’ve been filing lawsuits (including in Louisiana) and reinterpreting federal law to argue that a required “discount” should instead be a “rebate.” If they succeed, drugmakers will increase their profits at the expense of hospitals and patients. Even worse, they’re hoping that Republican lawmakers will cave and do their bidding. But former Trump administration officials have already warned that dismantling 340B would trigger a costly taxpayer bailout—all so pharmaceutical companies can inflate their earnings.
Trump Can Leverage His Strength Over Congress
For Trump to prove he’s serious about delivering on drug prices, he needs to capitalize on the fact that Americans trust him more than Congress. It will be impossible for voters to see Republicans as the party tackling prescription costs if a leading Republican senator is working to undercut a drug discount program and weaken insurers’ ability to negotiate lower prices.
Unlike Biden, Trump has never backed the left’s flawed Medicare drug price negotiation scheme—but that doesn’t mean he hasn’t pushed back on Big Pharma.
- His 2016 campaign proposed stronger price controls for Medicare drugs.
- His first administration implemented price ceilings on 340B drugs.
- As a businessman, he pushed for lower costs in the Trump Organization’s own employee health plan.
Trump’s record suggests that he understands how healthcare markets work, and he knows that giving the federal government the power to dictate prices is dangerous. But, allowing unchecked Big Pharma price hikes is just as bad.
Why This Matters for 2028 and Beyond
Trump is uniquely positioned to force Congress to take real action on drug pricing. The question is whether he will take that fight head-on or let lawmakers—who Americans already distrust—water down any real reform.
At the end of the day, whether he fights Big Pharma or not will determine how many voters believe he has truly Made America Great Again—again.
